1355 - Erythrocyte mean corpuscular volume change during pemetrexed treatment in advanced non small cell lung cancer patients

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Complications/Toxicities of Treatment
Non-Small Cell Lung Cancer
Therapy
Presenter Sebastiano Buti
Authors S. Buti1, P. Bordi2, M. Tiseo3, S. Panni4, S. Novello5, E. Bria6, S.G. Rapetti7, S. Pilotto8, R. Camisa2, A. Ardizzoni9
  • 1Oncologia, Azienda Ospedaliero-Universitaria di Parma, 43126 - Parma/IT
  • 2Oncologia Medica, Azienda Ospedaliero-Universitaria di Parma, IT-43100 - Parma/IT
  • 3Oncologia Medica, Azienda Ospedaliera di Parma, IT-43100 - Parma/IT
  • 4Oncologia, Azienda Istituti Ospitalieri di Cremona, 26100 - Cremona/IT
  • 5Department Of Clinical And Biological Sciences - Thoracic Oncology Unit, Azienda Ospedaliero-Universitaria ASOU San Luigi Gonzaga, 10043 - Orbassano (TO)/IT
  • 6Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona - "Borgo Roma", 37134 - Verona/IT
  • 7Department Of Clinical And Biological Sciences - Thoracic Oncology Unit, Azienda Ospedaliero-Universitaria ASOU San Luigi Gonzaga, 10043 - Orbassano/IT
  • 8Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona-"Borgo Roma", 37134 - Verona/IT
  • 9Oncologia Medica, Azienda Ospedaliero-Universitaria di Parma, 43126 - Parma/IT

Abstract

Introduction

Pemetrexed (Pem) has been approved for the treatment of advanced non small cell lung cancer (NSCLC) non-squamous histology, both as 1° and 2° line therapy with or without platinum compounds, respectively. Pem is an antimetabolite drug, that inhibits enzymes involved in nucleotides bio-synthesis arresting cancer cells cycle. Literature data show the effect of antimetabolities on increment of erythrocyte mean corpuscolar volume (MCV) in cancer patients (pts) treated with capecitabine and, recently, a positive correlation between increased MCV and response to capecitabine-based therapy has emerged [Arslan et al, Tumori 2011; Dellapasqua et al, Breast 2012]. The aim of this study was the evaluation of the impact of Pem on MCV change and its possible correlation with disease control rate (overall response + stable disease rate) (DCR), progression free survival (PFS) and overall survival (OS) in NSCLC pts.

Methods

A retrospective collection of clinical and laboratory data (including basal MCV and maximum MCV occurred during Pem therapy) in 165 advanced NSCLC pts treated with Pem from 4 Italian centres was performed.

Results

Pts characteristics: 59% men, median age 64 years (range 36-83), 58% ECOG PS 0, 90% stage IV and 10% stage IIIB (according 6th TNM), 87% adenocarcinoma histotype, 74% current or ex-smokers, 59% as 1° line, 41% as ≥ 2° line, 68% in combination with a platinum compound, median cycle 4 (range 1-29). All pts received vitamin B12 and folic acid supplementation. Mean MCV significantly increased from basal (89.6 fl) to “during treatment” (94.8 fl), with mean ΔMCV = 5.2 fl (t test for paired data, p < 0.0001). The median time from therapy start to maximum MCV was 2.3 months (mos). DCR was 84% and 62% [?2 test, p = 0.002], median PFS was 6.9 [CI95% 5.7-8.1] and 3.6 [CI95% 1.9-5.3] mos [p = 0.0019], and median OS was 16.0 [CI95% 7.9-24.1] and 10.8 [CI95% 9.0-12.6] mos [p = 0.0346], in ΔMCV > 5 fl (n = 68) and in ΔMCV ≤ 5 fl (n = 97) pts, respectively.

Conclusion

Pem induces significant increase of erythrocyte MCV. ΔMCV > 5 fl on Pem therapy appears to be correlated with better DCR, PFS and OS. These data should be related to a decreased metabolism of Pem and subsequent increased drug exposure in pts who develop higher ΔMCV during treatment. A larger prospective evaluation could be useful to better clarify these findings.

Disclosure

All authors have declared no conflicts of interest.